1407059082 NPI number — DR. ALNETTA LYSHAWN HOOPER PSY.D

Table of content: DR. ALNETTA LYSHAWN HOOPER PSY.D (NPI 1407059082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407059082 NPI number — DR. ALNETTA LYSHAWN HOOPER PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPER
Provider First Name:
ALNETTA
Provider Middle Name:
LYSHAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407059082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 E RIDGEWOOD AVE
Provider Second Line Business Mailing Address:
PMB 212
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07450-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-736-0867
Provider Business Mailing Address Fax Number:
866-724-3471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 E RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
PMB 212
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-736-0867
Provider Business Practice Location Address Fax Number:
866-724-3471
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  35SI00412300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com